| NPI | 1124387618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00426) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.003921) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: KY 00426) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2020-08-12 |